Makindo Medical Notes

Related Subjects: |Fever in a traveller |Bell's (Facial nerve) Palsy

Multisystem inflammatory disease caused by the spirochaete Borrelia burgdorferi.

About

• Lyme disease is a multisystem disease caused by Borrelia burgdorferi and related species.
• Transmitted primarily by Ixodid ticks (deer ticks).
• Common in the USA, Asia, and parts of Europe.
• Early recognition and treatment are crucial to prevent long-term complications.

Infectious agents

• Borrelia burgdorferi sensu lato (mainly in the USA).
• Borrelia afzelii and Borrelia garinii (primarily in Europe).
• All are transmitted by Ixodes ticks (e.g., I. scapularis, I. ricinus).

Seasonality

• More common in spring and summer months due to increased tick activity.
• Often associated with wooded or grassy areas.

Clinical Stages

Bannwarth's Syndrome

• A form of neuroborreliosis characterized by painful radiculitis, peripheral motor deficits, and lymphocytic CSF.
• Often includes facial palsies, multiple cranial neuropathies, radiculopathy, and meningoencephalitis.

Investigations

• Serology (ELISA, Western blot): May be negative early; nearly always positive in late disease.
• IgM or rising antibody titers suggest recent infection; however, false positives occur.
• PCR on CSF, joint fluid, or skin biopsy can be helpful, especially in neuroborreliosis.
• CSF: Lymphocytic pleocytosis, raised protein. MRI brain may show white matter changes.

Prevention

• Prompt tick removal (within 24 hours) decreases transmission risk.
• Use protective clothing and tick repellents in endemic areas.
• Check skin folds, scalp, behind knees, and other hidden areas after outdoor exposure.
• Vaccination available in some regions.
• Post-exposure prophylaxis: A single dose of Doxycycline 200 mg PO may reduce risk.

Management

• Treatment is based on clinical presentation and endemic exposure; serology may lag.
• Early disease: Doxycycline 100 mg BD for ~14 days (avoid in pregnancy/children, then use Amoxicillin).
• Alternatives: Amoxicillin, Cefuroxime, or in some cases Azithromycin.
• Late or disseminated disease: Longer courses (up to 30 days) of oral or IV antibiotics (e.g., Ceftriaxone, Benzyl Penicillin).
• Monitor for Jarisch-Herxheimer reaction (temporary worsening of symptoms after starting treatment).
• Carditis (AV block) usually improves with antibiotics; pacemaker rarely needed.
• Bell’s Palsy in Lyme can be treated with Doxycycline 100 mg BD for 2-4 weeks if no contraindications.

Additional Considerations

• Long-term sequelae can occur if untreated, affecting quality of life.
• Consult infectious disease specialists for complicated cases.
• Public health measures: Tick control, awareness, and prompt treatment are key.

References

• Centers for Disease Control and Prevention (CDC): https://www.cdc.gov/lyme/
• UpToDate: Lyme Disease.
• National Institute for Health and Care Excellence (NICE) Guidelines on Lyme Disease.